How to Improve Resident Care and Achieve a Citation-Free Survey

Briody Health Care Facility, located in Lockport, NY, is the oldest family owned and operated nursing facility in Western New York. For more than 65 years my family has provided a highly personalized level of care to all of our residents. Serving the residents of Eastern Niagara County, our facility maintains 82 inpatient beds to meet the needs of residents requiring long-term skilled nursing care and short-term rehabilitation. We also provide outpatient services to individuals in the community in need of physical, occupational or speech therapies.

Our Challenge

As the third generation to own and operate Briody Health Care Facility, I (and our staff) take great pride in providing outstanding quality care. As validation of our efforts, our facility has historically achieved excellent results in traditional state surveys, earning zero deficiencies several times in the past decade. In March 2011, we had our first Quality Indicator Survey (QIS). We prepared for it similarly to the way we had done in the past, but we knew QIS was different from the traditional survey and experienced this first hand with our first QIS.

The new QIS is more consistent and less subjective than the traditional state survey with a resident-centered/customer service focus. QIS encourages providers of skilled nursing facilities to interview residents and family members and solicit feedback about their satisfaction with the care they are receiving.

After our first QIS survey, we realized we needed to change the way we evaluated the care we provided. More importantly, we also needed to identify opportunities for growth to assist us in delivering the best care for our residents.

The Solution

Several months prior to our first QIS, we had attended a presentation about a new quality assurance system called abaqis. It had a lot of attractive benefits such as addressing many of the same questions as the QIS. But my initial thought was that while it seemed like an innovative tool, it was too expensive for us.

Over the course of the next several months, we came across several facilities that were using abaqis. Many of the people I talked with found that it did more than help them prepare for QIS. It also was a very effective year-round quality assurance system.

After our first QIS, which uncovered areas where we needed improvement, I called my Medline sales representative to demonstrate the benefits of abaqis for our management team and department heads. Medline is our health care supply company and the exclusive distributors of abaqis. We were impressed with how abaqis replicated the methods and procedures of the QIS. We made the analogy that our next QIS would be like an open book test. Our employees would know exactly what was on the survey and what the issues were among our residents.

We also liked that abaqis was a web-based program that uses the same calculations, thresholds and analysis as the QIS to quickly highlight residents at risk. When information from a resident or family interview is entered into the program, abaqis immediately directs us to areas of concern where specific issues could develop. For instance, if a resident voices a concern about food quality, abaqis will point out the root of the problem. It highlights areas that this issue could impact, such as nutrition, weight loss or dietary system failure.

In September, we held an initial training session with Providigm (the developers of abaqis) for the management team and department heads. The idea was that these initial abaqis users would become the trainers for the program as we slowly rolled it out to our 160 staff members, including unit coordinators, charge nurses, LPNs, social workers, CNAs and other ancillary staff.

The plan was to roll out abaqis in three phases. Phase I took place in September and October when we conducted 40 interviews with our residents, family members, and staff. We also performed observations and took our admission and census samples.

Uncovering and Solving Issues

After the initial phase of observations and interviews, abaqis identified areas that could be flagged for a deficiency. In Phase II of our implementation, we met with the staff, like a mock exit interview, and explained all the issues we found and developed a game plan to resolve those issues.

We discovered during the interview process a specific issue one of our residents was having with their care. One of our regular caregivers had taken a leave of absence and the new CNAs assigned to this resident did not know her as well. During the interview process, the resident expressed her frustration with her care and I immediately uncovered the problem. We worked on updating the resident’s care plan with her input, offered her choices and honored her reuests. The result was a much happier resident because she felt we listened to her concerns and had a say in her quality of care.

Three weeks later when the surveyors came, they asked the exact same questions as abaqis. So, what could have turned out to be a major issue with our survey was a non-event since we had identified and resolved the problems prior to the survey. This is the essence of abaqis. It helps us to be proactive regarding improving resident care and quality of life.

The ultimate testament to abaqis’ effectiveness was this past March when we had our second QIS. We received no Residents of Briody Health Care can get their breakfast made to order each day, including eggs and other freshly prepared food deficiencies and we attribute a significant part of this success to implementing abaqis back in the fall. Our staff was thrilled with the results, especially after our experience with the first QIS, and were much more confident going into the second survey.

Staff More Engaged With Residents

Abaqis helps us objectively look at the services we provide through the eyes of our residents and uncover issues we may not have discovered otherwise.

For instance, we recently made a major change with our breakfast service as a result of the findings from the abaqis interviews. Through resident feedback, we realized that open dining service for breakfast, with “cook to order” food, was the best way for us to provide excellent quality food and a wonderful dining experience. Our traditional breakfast tray service either in the resident’s room or in a group setting did not afford the best possible quality of food. For example, we were never able to master crispy toast with tray service and our residents’ feedback through abaqis confirmed that we had to do better. Residents can now come to our dining area to get their breakfast fresh and made to order. They also have the opportunity to spend more social time with the other residents.

Residents of Briody Health Care can get their breakfast made to order each day, including eggs and other freshly prepared food.

Since implementing abaqis, residents feel and see the difference in the care being provided by our staff. They are experiencing a lot more interaction with our staff in terms of more choices and being asked for their opinions on how we can make their lives better.

Phase III is now underway in which our department heads are rolling out abaqis to our other staff members, including CNAs, LPNs and other ancillary workers. Our staff is now more engaged with our residents, patients and family members and feels they are making more of a difference in their quality of life and satisfaction.

New Readmissions Tracker

With the Affordable Care Act (ACA) stipulating that hospitals (and possibly nursing homes in the future) help pay for avoidable re-hospitalizations, we are beginning to review our readmission efforts. Recently, abaqis introduced a new readmissions tracker and analysis module that will be a tremendous aid in helping us obtain our readmission rates and uncover quality of care issues.

This article was originally published in Provider Magazine and reblogged with permission.

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About the Author

Ann Briody Petock is a licensed registered nurse and licensed nursing home administrator. Ann and her family have owned and operated Briody Health Care Facility located in Lockport, New York. Briody Health Care Facility is an 82-bed skilled nursing facility that specializes in short-term rehabilitation, outpatient rehabilitation and long-term care. The facility has been caring for the Lockport Community for more than 65 years.

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